Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are recommended for the medium- to long-term management of knee osteoarthritis (OA) due to their abilities to control pain, improve function and delay joint structural changes. Among SYSADOAs, evidence is greatest for the patented crystalline glucosamine sulfate (pCGS) formulation (Mylan). Glucosamine is widely available as glucosamine sulfate (GS) and glucosamine hydrochloride (GH) preparations that vary substantially in molecular form, pharmaceutical formulation and dose regimen. Only pCGS is given as a highly bioavailable once-daily dose (1500 mg), which consistently delivers the plasma levels of around 10 μmol/L required to inhibit interleukin-1-induced expression of genes involved in the pathophysiology of joint inflammation and tissue destruction. Careful consideration of the evidence base reveals that only pCGS reliably provides a moderate effect size on pain that is higher than paracetamol and equivalent to non-steroidal anti-inflammatory drugs (NSAIDs), while non-crystalline GS and GH fail to reach statistical significance for pain reduction. Chronic administration of pCGS has disease-modifying effects, with a reduction in need for total joint replacement lasting for 5 years after treatment cessation. Pharmacoeconomic studies of pCGS demonstrate long-term reduction in additional pain analgesia and NSAIDs, with a 50% reduction in costs of other OA medication and healthcare consultations. Consequently, pCGS is the logical choice, with demonstrated medium-term control of pain and lasting impact on disease progression. Physician and patient education on the differentiation of pCGS from other glucosamine formulations will help to improve treatment selection, increase treatment adherence, and optimize clinical benefit in OA.
The dissolved organic matter (DOM) in the ocean is a large carbon pool that plays an important role in the global carbon cycle. Investigation of the characteristics and behaviors of DOM in some areas facilitates a better understanding of biochemical processes in the water column. In February 2020, water samples were collected to characterize the distribution and optical properties of DOM from the Northern Andaman Sea and the Northeastern Bay of Bengal. A high dissolved organic carbon (DOC) concentration appeared in the Northern Andaman Sea, which is strongly affected by the DOM contents of the Irrawaddy and Salween Rivers. A barrier layer that resulted from the freshwater input was observed above the thermocline. This layer was believed to have had a consistent effect on the concentration of DOM in the surface water and contributed to the differences in DOC concentration on each side of the Preparis Channel. Based on the fluorescence excitation emission matrix and parallel factor analysis, four fluorescent components were identified, including three humic-like components (C1, C2, and C4 with their maximal Ex/Em at ≤240/418 nm, 315/384 nm, and 270 (360)/442 nm and represented as peaks A, M, and A+C, respectively) and one protein-like component (C3 with maximal Ex/Em at 275/334 nm and represented as peak T). The humic-like components were mainly derived from terrestrial inputs. Low levels of humic-like components were confined in the upper water, with strong photodegradation in the euphotic zone. C3 was a typical tryptophan-like component that represented freshly produced autochthonous DOM. The correlation between C3 and biological index and apparent oxygen utilization suggested that it was highly bioavailable and not easy to be preserved in the deep sea. Overall, our results showed the distributions of DOM in the Northern Andaman Sea and the Northeastern Bay of Bengal and revealed the behaviors and controlling factors for DOM in the upper water.
A 34-year-old woman presents with three weeks of dyspnoea and pleuritic chest pain. Nine months prior the patient underwent mastectomy with adjuvant chemo-radiotherapy for stage IIB ductal carcinoma; now in clinical remission. On presentation she was hypoxic and tachycardic
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